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En almindelig årsag til, at patienter søger nødbehandling af forhold i mundhulen, er den bakterieinducerede inflammation i pulpa samt det periapikale væv. At have et godt kendskab til diagnostik og differentialdiagnostik er af afgørende betydning for den korrekte behandling, som indbefatter anamnese, objektiv klinisk undersøgelse samt evt. røntgenundersøgelse. På baggrund af en vægtet vurdering af alle disse indirekte data tages der stilling til diagnosen. Hvis en diagnose ikke er muligat stille, bør der ikke udføres invasive procedurer. Behandling i den akutte situation er typisk et fokus på smertelindring og mulig infektionskontrol, og hvor der tages højde for diagnostiske vanskeligheder samt den ofte forekommende tidmangel. Egnet smertestillende middel i mild til moderat smerte er paracetamol. Hvis der er en tydelig inflammatorisk komponent i smertebilledet, bør primært et NSAID-præparat anvendes som et alternativ eller som et supplement. I tilfælde af alvorlig smerte, eller hvis der ikke opnås tilstrækkelig smertelindring, anbefales tilskud med opioidindeholdende smertestillende middel. Til infektionskontrol bør i første omgang foretages incision af fluktuerende hævelser, trepanering af kronen og dræning gennem rodkanalerne, eller egentlig ekstraktion bør overvejes. Indikationen for antibiotikum er kun begrænset til situationer, hvor den almene tilstand er påvirket, herunder hvis der er spredning af infektionen. I tilfælde, hvorantibiotikumbehandling overvejes, er penicillin V et førstelinjepræparat. Kun i tilfælde af penicillinallergi anbefales clindamycin.

Vitale pulpabehandlinger udføres med henblik påat bevare pulpas forsvarsfunktioner og undgå pul-pektomi og rodfyldning, som kan være teknisk ud-fordrende og ikke altid fører til det ønskede resultat.The European Society of Endodontology (ESE) harpubliceret en statusrapport om vital pulpabehand-ling i tænder med profunde carieslæsioner, som iet vist omfang stemmer overens med de nationaleretningslinjer i de nordiske lande. Der er stadig pro-blemer med at vurdere pulpas tilstand i tænder medprofunde carieslæsioner. Så længe carieslæsionenikke har nået pulpa, anbefales behandlinger, dersigter på at undgå pulpaeksponering, fx gradvis eks-kavering. Men når pulpa er eksponeret på grundaf caries, er der ikke overensstemmelse mellemanbefalingerne fra ESE og de nordiske landes na-tionale retningslinjer. Dette skyldes sandsynligvismanglende evidens for bedre effekt af én behand-ling frem for andre samt vanskeligheder med atafgøre, hvornår pulpa er irreversibelt beskadiget.Minimalt invasive behandlingsstrategier med ny-udviklede hydrauliske calciumsilikatcementer harvist lovende resultater af vital pulpabehandling medhenblik på at undgå rodkanalbehandling. Koncepteter under stadig udvikling, og man må forvente, at dekliniske anbefalinger på sigt bliver ændret.

För att minska kunskapsluckorna inom odontologin krävs samarbete mellan lärosätena. Det ger även möjlighet till akademisk meritering, vilket är angeläget då antalet seniora forskare med behörighet för forskningshandledning i Sverige är färre än någonsin. EndoReCo (Endodontic Research Collaboration) är ett skandinaviskt forskningsnätverk i endodonti som kan ta del av just dessa fördelar.

To assess the efficiency of AI methods in finding radiographic features in Endodontic treatment considerations. This review was based on the PRISMA guidelines and QUADAS 2 tool. A systematic search was performed of the literature on cases with endodontic treatments, comparing AI algorithms (test) versus conventional image assessments (control) for finding radiographic features. The search was conducted in PubMed, Scopus, Google Scholar and the Cochrane library. Inclusion criteria were studies on the use of AI and machine learning in endodontic treatments using dental X-rays. The initial search retrieved 1131 papers, from which 24 were included. High heterogeneity of the materials left out a meta-analysis. The reported subcategories were periapical lesion, vertical root fractures, predicting root/canal morphology, locating minor apical foramen, tooth segmentation and endodontic retreatment prediction. Radiographic features assessed were mostly periapical lesions. The studies mostly considered the decision of 1–3 experts as the reference for training their models. Almost half of the included materials campared their trained neural network model with other methods. More than 58% of studies had some level of bias. AI-based models have shown effectiveness in finding radiographic features in different endodontic treatments. While the reported accuracy measurements seem promising, the papers mostly were biased methodologically.

Objective: To determine whether calibration improves observer reliability when assessing DMFT-score, root-filled teeth and periapical lesions on panoramic radiographs. Material and methods: A sample of 100 panoramic radiographs was selected from a cohort of myocardial infarction patients (n = 797) and matched controls (n = 796). The following variables were assessed: DMFT-score, remaining teeth, root-filled teeth and periapical lesions. Two specialists, an endodontist and a radiologist, served as reference examiners and undertook two separate assessments. Disagreement cases were jointly assessed and the final results were used as the reference standard. Three observers undertook three separate assessments, the first without prior training, the second after calibration against the reference standard and the third with the sample concealed in the complete material. Statistical analysis was made with Wilcoxon Signed rank test and Sign test. Agreement was calculated as Intraclass Correlation Coefficient (ICC) (95% CI) and Weighted Kappa (κ) (95% CI). Results: Periapical lesions disclosed high inter-observer variability for the reference examiners and diverged significantly between the observers and the reference standard. For the reference examiners, inter-observer agreement was κ = 0.53. The observers, in their first assessments had κ values ranging from 0.22 to 0.60 in relation to the reference standard. Following calibration, the κ values increased, ranging from 0.59 to 0.80. For the third assessment, the κ values ranged from 0.54 to 0.75. DMFT-score, remaining teeth and root-filled teeth disclosed high reliability throughout all assessments (ICC = 0.88-0.98 and κ = 0.98–0.99). Conclusions: DMFT-score, remaining teeth and root-filled teeth can be reliably assessed on panoramic radiographs. Calibration against a reference standard improves observer reliability in the detection of periapical lesions.

Aim: To study the association between endodontic inflammatory disease and a first myocardial infarction (MI). Methodology: The study comprised 805 patients with recent experience of a first MI, each gender, age and geographically matched with a control. Panoramic radiographs were available for 797 patients and 796 controls. Endodontic inflammatory disease was assessed radiographically. The sum of decayed, missing and filled teeth (DMFT) was calculated, and the number of root filled teeth and teeth with periapical lesions were recorded. The associated risk of a first MI was expressed as odds ratios (OR) with 95% confidence intervals (CI), unadjusted and adjusted for confounders (family history of cardiovascular disease, smoking habits, marital status, education and diabetes). Results: Patients who had suffered a first MI had higher DMFT (mean 22.5 vs. 21.9, p =.013) and more missing teeth (mean 7.5 vs. 6.3; p